Health systems rush to partner with booming retail clinic market, report says

One issue driving the change: 30.7 percent of insured consumers said that the cost was lower than another source of care.

Health systems have formed more than 100 partnerships with retail health clinics, according to a new study published by the Robert Wood Johnson Foundation and Manatt Health, as consumer interest in easy-access, lower-cost care is changing the market.

The bulk of the estimated 1,800 retail clinics are owned by pharmacies and big-box retailers, with the six largest being CVS MinuteClinic, Walgreens Healthcare Clinic, Kroger Little Clinic, Walmart Retail Clinics, Target Clinic and RiteAid RediClinic, according to the study.

The partnerships link care between the retail sites and primary care medical facilities. Health system affiliations include relationships with a single physician group to a large, integrated delivery system. CVS MinuteClinic, which has the largest number of sites at 901, has a 50 percent market share and 47 health system affiliations.

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"If a patient has a medical home and they have a relationship with the primary care setting, and they in turn, have an agreement to use the retail setting for maintenance and routine evaluation, and that information will flow back to the medical home, that creates a shared responsibility," said Shawn Martin, vice president of Advocacy and Practice Advancement for the American Academy of Family Physicians. "The key is coordination and linkage back to the medical home …"

The report found consumer use of a retail clinic over the past 12 months included the following reasons: 58.6 percent said the hours were more convenient; 55.9 percent said there was no need to make an appointment; 48.1 percent said the location was more convenient; 38.7 percent said the cost was lower; and 24.6 percent said they had no usual source of care.

In terms of cost, 30.7 percent of insured consumers said that the cost was lower than another source of care.

"Clearly there's a need because they've sprung up and they're filling a gap," said Doris Peter, director of Health Ratings Center Consumer Reports.

The biggest concern, she said in the report, is the lack of transparency regarding quality and the need to be accountable and scrutinized to the same extent as other providers.

The report states retail clinics have low margins and low overhead; they cost $50,000 to $250,000 to build out; need a small footprint of between 150- and 250-square-feet; and can generate up to $500,000 a year in revenue.

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They see about 10 to 30 patients per day; offer low prices, from $40 to $75 a visit; and aggressively manage their supply chain.

Since emerging on the healthcare landscape more than 15 years ago, retail clinics are now common, logging 10.5 million visits each year at more than 1,800 sites.

Retail clinics have seen rapid growth.The number of visits increased from 1.5 million in 2007 to 10.5 million in 2012, representing about 2 percent of primary care encounters in the United States.

By 2008, most retail clinics accepted insurance, both commercial and Medicare and 60 percent accept Medicaid.

The Affordable Care Act  has also helped lower the numbers of uninsured from 16 percent in 2009 to 12.9 percent in the fourth quarter of 2014 through Medicaid expansion.

Retail clinics are filling a gap in the healthcare system for those uninsured or underinsured, for families with immediate needs on weekends and evenings and for employers, health systems and insurers looking to lower cost of care for low acuity conditions, the report stated.

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The move expands care after hours and offers an alternative to emergency room care. One study estimates that up to 27 percent of emergency room visits could be handled appropriately at retail clinics and urgent care centers, offering a cost savings of $4.4 billion per year.

Increasingly, retailers are bundling clinic services with pharmacy, nutrition, lifestyle and obesity management programs.